Somalia's Drought-Disease Spiral: Climate Shocks as an Emerging Public Health Security Threat.

This narrative commentary examines Somalia's drought-disease spiral using selected published literature, humanitarian reports, surveillance updates, and climate-health evidence. It focuses on how recurrent droughts, floods, food insecurity, displacement, malnutrition, and fragile health-system capacity interact to increase the risk of climate-sensitive infectious diseases. Somalia is among the countries most vulnerable to climate variability, and repeated environmental shocks have intensified humanitarian needs while placing additional pressure on an already fragile health system. Recent climate-related crises have contributed to severe food insecurity, large-scale internal displacement, limited access to safe water and sanitation, and recurrent outbreaks of infectious diseases, including cholera, acute watery diarrhea, measles, and diphtheria. Malnutrition, particularly among children and displaced populations, further increases vulnerability to infection and worsens health outcomes. This commentary argues that climate-related health threats in Somalia should be understood not only as humanitarian emergencies but also as public health security and risk-management challenges. The drought-disease spiral reflects the convergence of environmental hazards, weak WASH conditions, overcrowded internally displaced persons settlements, undernutrition, and limited surveillance and response capacity. Breaking this cycle requires a shift from repeated emergency response toward anticipatory prevention and resilience-building. Priority actions include strengthening climate-informed disease surveillance, integrating climate and health early warning systems, expanding WASH services in internally displaced persons settlements and other vulnerable communities, investing in climate-resilient health facilities, improving nutrition-sensitive outbreak preparedness, and strengthening multisectoral coordination across health, WASH, nutrition, climate, livestock, and humanitarian sectors. These actions are essential to reduce preventable disease, protect vulnerable populations, and strengthen health-system resilience in Somalia.